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Paper money and coins as potential vectors of transmissible disease

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  • URMITE CNRS-IRD 198 UMR 6236

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Paper currency and coins may be a public health risk when associated with the simultaneous handling of food and could lead to the spread of nosocomial infections. Banknotes recovered from hospitals may be highly contaminated by Staphylococcus aureus. Salmonella species, Escherichia coli and S. aureus are commonly isolated from banknotes from food outlets. Laboratory simulations revealed that methicillin-resistant S. aureus can easily survive on coins, whereas E. coli, Salmonella species and viruses, including human influenza virus, Norovirus, Rhinovirus, hepatitis A virus, and Rotavirus, can be transmitted through hand contact. Large-scale, 16S rRNA, metagenomic studies and culturomics have the capacity to dramatically expand the known diversity of bacteria and viruses on money and fomites. This review summarizes the latest research on the potential of paper currency and coins to serve as sources of pathogenic agents.
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249
ISSN 1746-0913
Future Microbiol. (2014) 9(2), 249–261
REVIEW
Background
Healthcare-associated infections are one of the most serious patient safety issues in healthcare
today [1] . Most pathogens are able to survive on surfaces and these surfaces can act as sources of
pathogen transmission if no disinfection is performed. In addition, the survival of nosocomial
pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), in the environment is of
great interest to infection control professionals [2]. Moreover, food workers have been implicated
in several outbreaks of food-borne diseases and human occupational activities could introduce the
risk of food contamination [3]. Pathogens that can infect food workers have multiple sources and
contaminated workers in turn become potential sources of contamination in food processing and
preparation facilities [4].
Fomites are inanimate objects capable of absorbing, harboring and transmitting infectious micro-
organisms [5,6]. Banknotes and coins are handled by persons of varying health and hygienic standards,
and are stored under varying environmental and personal hygienic conditions. Paper currency is
widely exchanged for goods and services. Both paper banknotes and coins offer ample surface area
to harbor bacteria and microorganisms, and the hygienic status of currency has been a scourge to
some for over a century [5] . Several authors have raised the concern that banknotes and coins could
serve as vectors for the transmission of disease-causing microorganisms [5,6]. Microbial contami-
nants may be transmitted directly, through hand-to-hand contact, or indirectly, via food or other
inanimate objects. As a result, hand hygiene is considered critical for preventing food outbreaks and
healthcare-associated infections [1] . However, only few data are available about the types of patient
REVIEW
part of
10.2217/FMB.13.161 © 2014 Future Medicine Ltd
REVIEW
Paper money and coins as potential
vectors of transmissible disease
Emmanouil
Angelakis*
,1
, Esam I
Azhar
2,3
, Fehmida
Bibi
3
, Muhammad
Yasir
3
, Ahmed K
Al-Ghamdi
3
, Ahmad M
Ashshi
4
, Adel G
Elshemi
1,2,3,4
&Didier
Raoult
1,2
1
URMITE CNRS-IRD 198 UMR 6236, Université de la Méditerranée, Faculté de Médecine et de Pharmacie, 27 Boulevard Jean Moulin,
13385 Marseille, France
2
Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
3
Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
4
Department of Laboratory Medicine, Faculty of Applied Medical Science, Umm Al-Qura University, Makkah, Saudi Arabia
*Author for correspondence: Tel.: +33 491 38 55 17; Fax: +33 491 83 03 90; angelotasmanos@msn.com
ABSTRACT: Paper currency and coins may be a public health risk when associated with
the simultaneous handling of food and could lead to the spread of nosocomial infections.
Banknotes recovered from hospitals may be highly contaminated by Staphylococcus aureus.
Salmonella species, Escherichia coli and S. aureus are commonly isolated from banknotes
from food outlets. Laboratory simulations revealed that methicillin-resistant S. aureus can
easily survive on coins, whereas E. coli, Salmonella species and viruses, including human
inuenza virus, Norovirus, Rhinovirus, hepatitis A virus and Rotavirus, can be transmitted
through hand contact. Large-scale, 16S rRNA, metagenomic studies and culturomics have
the capacity to dramatically expand the known diversity of bacteria and viruses on money
and fomites. This review summarizes the latest research on the potential of paper currency
and coins to serve as sources of pathogenic agents.
KEYWORDS
coins fomites paper
money transmissible
disease
Future Microbiol. (2014) 9(2)
250
care activities that are able to transmit the patient
flora to healthcare workers’ hands. In addition,
it remains unclear how long bacteria can survive
on paper or how many organisms may be trans-
ferred in a full hand-to-paper-to-hand transmis-
sion cycle [1] . Although little has been written
concerning the potential of banknotes, coins
and fomites to become reservoirs and vehicles
for the transmission of pathogens, the data have
been quietly accumulating. Here, we review the
infectious potential of coins, currency notes and
fomites.
Search strategy
We searched PubMed, Web of Science, Google
and Google Scholar databases for peer-reviewed,
English-language articles with no date restric-
tions. The search terms were combinations of
bacteria, virus, yeast, fungi, infection, transmis-
sion’ and ‘coins’, ‘currency notes’, ‘banknotes’,
fomites’, ‘dirty money’, ‘hands’ and ‘surfaces’.
The literature was also searched for every patho-
gen identified by the previous search; for exam-
ple, ‘S. aureus, hepatitis A virus (HAV) and so
on’ and ‘coins’, ‘currency notes’, ‘banknotes’,
fomites’, ‘dirty money’, ‘hands’ and ‘surfaces’.
We also examined the references cited in the
identified articles and searched PubMed for
other papers by the authors of the identified
articles. When necessary, we contacted the cor-
responding authors for further clarification or
additional information.
Persistence of pathogens on surfaces
Important factors for the survival of pathogenic
agents on surfaces are the presence of organic
matter, solar irradiation, temperature and
humidity [7]. A recent review reported that many
Gram-positive bacteria, such as Enterococcus spp.,
S. aureus and Streptococcus pyogenes, and Gram-
negative bacteria, such as Acinetobacter spp.,
Escherichia coli, Klebsiella spp., Pseudomonas
aeruginosa, Serratia marcescens and Shigella spp.,
can survive for months on surfaces [8]. In addi-
tion, mycobacteria and Clostridium difcile can
survive for months, while other pathogens, such
as Bordetella pertussis, Haemophilus influenzae,
Proteus vulgaris or Vibrio cholera, persist only for
days [8]. Candida albicans can survive for up to
4 months on surfaces, whereas respiratory tract
viruses, such as Coronavirus, Coxsackievirus,
Influenza virus, severe acute respiratory syn-
drome-associated virus or Rhinovirus, can per-
sist on surfaces for a few days [8]. Noroviruses
are environmentally stable, able to survive both
freezing and heating (although not thorough
cooking), and resistant to many common chemi-
cal disinfectants, and can persist on surfaces for
up to 2 weeks [9] . Herpes viruses persist for only
a few hours to 7 days, and viruses of the GI
tract, such as Astrovirus, HAV, Poliovirus and
Rotavirus, persist for approximately 2 months [8] .
Currency notes
Paper currency is commonly and routinely
passed among individuals, and microbes can be
spread on the surface of paper currency (Figure 1).
Paper currency is made of a rugged mix of 75%
cotton and 25% linen, and offers surface area for
bacteria and microorganisms to reside on both
sides [10] . Polymer-based banknotes presented
lower bacterial counts than cotton-based bank-
notes [11] . It is possible that the fibrous surfaces of
cotton-based banknotes provide a good surface
for bacterial attachment [11] . As a result, fewer
bacteria were isolated in Australia and New
Zealand, where polymer-based banknotes were
tested [11] . Moreover, in banknotes from Mexico,
where both polymer and cotton-based notes are
used, it was found that polymer-based banknotes
were much less contaminated than cotton-based
notes [11] . The longer the paper bill remains in
circulation, the more opportunity there is for it to
become contaminated, and lower-denomination
notes receive the most handling because they
are ex-changed more often [10,11] . In addition,
the economic status of a country was associated
with the concentration of bacteria on the cur-
rency, and it was found that the average number
of bacteria detected on banknotes is associated
with the economic freedom of banknotes [11] .
Bacteria
The amount of bacterial contamination on cur-
rency varies widely between countries (Figure2).
As a result, 88% of the paper notes tested in
Jeddah, Saudi Arabia were contaminated with
a variety of microorganisms [12] , and 94% of
US$1 bills had bacterial contamination [13] .
Approximately 80% of the paper notes tested in
Bangladesh and 89% of the paper notes tested in
Nigeria had bacterial contamination, whereas in
Ghana, 100% of the currency notes tested were
found to be contaminated with one or more bac-
terial species [14] . However, no difference was
found in the bacterial presence among cotton-
based notes from Nigeria, The Netherlands
and Mexico [11] . In addition, more bacterial
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251
contamination existed on older Egyptian [10]
and Saudi Arabian paper notes than on new
ones [12] . The number of bacteria per square cm
on banknotes was also different between coun-
tries. As a result, polymer-based banknotes from
Australia and New Zealand presented less than
10/cm
2
bacteria, whereas cotton-based notes
from China presented more than 100/cm
2
bac-
teria [11] . Cotton-based notes from the USA con-
tained about 10/cm
2
bacteria [11] . By contrast, on
currency from Rangoon, Myanmar, total bacte-
ria and fecal coliform counts were much higher,
ranging from 0–2.9 × 10
7
/cm
2
[15 ] . The num-
ber of bacteria on currency also varies within
a single country, as the number of bacteria iso-
lated from US currency varied from 20 to 2.5
× 10
4
CFU [11] . In Nigeria, currency notes had
also a high level of contamination, reaching 4 ×
10
5
CFU [16] . Various bacteria have been isolated
from money worldwide, includ-ing developed
countries, and microbes, such as S. aureus,
E. coli, Klebsiella spp. and Enterobacter spp.,
have been identified as common contaminants
(Table1) . In the 1970s, Abrams and Waterman
found that the 42% of paper currency collected
from laboratory personnel was contaminated by
potential pathogens, such as S. aureus, E. coli,
Klebsiella sp., P. aeruginosa and Proteus mirabilis
[6]. Similarly, US$1 bills and Egyptian paper
money yielded pathogenic agents, such as S.
aureus and Klebsiella pneumonia, or other bac-
terial contaminants, such as coagulase-negative
staphylococci, α-hemolytic streptococci and
Acinetobacter sp. [10,13] . In India, approximately
1869 CFU of S. aureus were isolated per
banknote [17] . Moreover, many bacterial agents
have been isolated from banknotes in studies
from India, Bangladesh, Saudi Arabia, Turkey,
Figure 1. Most common pathogens detected in banknotes and coins.
Gram-negative contaminants Escherichia coli Polymicrobian
Staphylococcus aureus Fungi Parasites
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Future Microbiol. (2014) 9(2)
252
Nigeria, Kenya, Pakistan, Myanmar, Egypt and
Nepal (Table 1) [15,16,1827]. In addition, Vibrio
cholera were isolated from paper money samples
obtained from Bangladesh [21] ; Vibrio sp. have
also been detected in Rangoon, Myanmar [15]
and India [18]. In a recent study on banknotes
from different countries, it was found that E. coli
was most commonly isolated on banknotes from
the USA and China, and a Salmonella sp. was
isolated only from samples in the USA, China
and Ireland, while the presence of S. aureus
varied [11] . Moreover, bacterial isolates from
currency exhibited a high incidence of antibi-
otic resistance [11] . In summary, several bacteria
species have been isolated from banknotes from
different countries.
Other agents
In a study performed in the 1970s, various
yeast and fungi were isolated from paper cur-
rency collected from laboratory personnel [6] .
In addition, 118 saprophytic fungal isolates
were isolated from currency notes in India [19] .
More recently, fungi were isolated from both
old and new currency notes in Riyadh, Saudi
Arabia [26] . The most commonly isolated fun-
gal species was Aspergillus niger, followed by
Aspergillus flavus, Candida spp., Penicillium
spp. and Rhizopus spp. [26] . In another study in
India, currency notes from different occupa-
tional groups were evaluated for the presence
of microbial contaminants, and fungi such
as Aspergillus niger and Fusarium spp. were
Escherichia coli
Bacillus sp.
Staphylococcus aureus
Coagulase-negative staphylococci
Pseudomonas aeruginosa
Pseudomonas sp.
Salmonella sp.
Enterococcus sp.
Streptococcus sp.
Klebseilla sp.
Proteus mirabilis
Acinetobacter sp.
Aerobacter sp.
Yersinia sp.
Enterobacter spp.
Shigella sp.
Vibrio sp.
Aspergillus sp.
Candida spp.
Fusarium spp.
Rhizopus spp.
Penicillium spp.
Ascaris lumbricoides
Enterobius vermicularis
Trichuris trichiura
Taenia spp.
USA
India
Myanmar
Turkey
China
Saudi Arabia
Bangladesh
Nepal
Nigeria
Kenya
Europe
Australia
Pakistan
New Zealand
Egypt
Canada
Philippines
Figure 2. Infectious agents isolated from paper currency from dierent countries.
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isolated from these currency notes, in addition
to common pathogenic bacteria [30] .
Currency notes contaminated with parasites
were found in a study performed in Nigeria [29] .
Notes were found to be contaminated with Ascaris
lumbricoides (8%), Enterobius vermicularis (7%),
Trichuris trichiura (3%) and Taenia spp. (4%)
[2 9]. Moreover, parasitic contamination was most
prevalent on dirty/mutilated notes collected from
butchers, farmers and beggars [29].
Coins
Few studies have examined the contamination of
coinage, and copper (Cu) seems to be a limiting
factor for bacterial survival on coins [28] . As a
result, coins have been found to carry opportun-
istic bacterial pathogens, but they exhibit a lower
bacterial load than paper currency [28] .
Bacteria
Coins have been shown to carry opportunistic
pathogens, such as a variety of species of the gen-
era Staphylococcus, Bacillus, and Corynebacterium
(Table 1) [28,31] . Abrams and Waterman found
that 13% of the coins collected from labora-
tory personnel were contaminated by poten-
tial pathogens, such as S. aureus, Klebsiella sp.,
P. aeruginosa and P. mirabilis [6] . Many different
species were also isolated on coins from Kenya,
and the average bacterial content on the coins
ranged from 2.3 to 25 × 10
3
CFU (Table 1) [22] .
Most commonly, Gram-positive staphylococci
and micrococci were isolated from EU¢50
coins collected in Germany and Portugal
(Table 1) [28] . The absence of streptococci iso-
lates from coins probably suggests a high sen-
sitivity of these bacteria to metallic Cu [28] . In
a recent study on the bacterial flora collected
from coins from 17 countries, all of the isolates
from coins were Gram-positive strains, with
the majority belonging to the genera Bacillus
(40%) and Staphylococcus (28%) (Figure3) [31] .
Recently, Pseudomonas psychrotolerans and
Roseomonas pecuniae were isolated from EU¢50
coins Cu-alloy coins [32,33]. Multiple genes that
are potentially involved in Cu resistance were
identified in these bacteria [32] .
Other agents
Yeast and fungi were isolated from coins collected
from laboratory personnel [6]. More recently,
Penicillium spp, Aspergillus niger, Fusarium,
Rhizopus, Altenaria spp, Candida spp. and
Cryptococcus were isolated from Kenyan coins [22].
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Table 1. Most important pathogens isolated from banknotes or coins.
Pathogens Banknotes Coins Ref.
Escherichia coli Yes Yes [6]
Bacillus sp. Yes Yes [18,22]
Staphylococcus aureus Yes Yes [6,17]
Coagulase-negative staphylococci Yes Yes [10,13,28]
Pseudomonas aeruginosa Yes Yes [6]
Salmonella sp. Yes No [18]
Enterococcus sp. Yes Yes [22]
Klebsiella sp. Yes Yes [6,18]
Proteus mirabilis Yes Yes [6,18]
Acinetobacter sp. Yes Yes [10,13,22]
Yersinia sp. Yes No [26]
Enterobacter sp. Yes Yes [22,25]
Shigella sp. Yes No [25]
Vibrio sp. Yes No [18]
Aspergillus Yes Yes [22,26]
Cryptococcus No Yes [22,26]
Candida spp. Yes Yes [22,26]
Rhizopus spp. Yes Yes [22,26]
Penicillium spp. Yes Yes [22,26]
Ascaris lumbricoides Yes No [29]
Enterobius vermicularis Yes No [29]
Trichuris trichiura Yes No [29]
Taenia spp. Yes No [29]
Future Microbiol. (2014) 9(2)
254
Fomites & money in the spread of
nosocomial infections
It is believed that the main route of transmission
of most pathogens is via the transiently contami-
nated hands of the healthcare worker [34]. A single
contact of a hand with a contaminated surface
can result in a variable degree of pathogen trans-
fer [8] . In hospitals, surfaces, such as beds and
keyboards, that come into contact with hands
serve as reservoirs of nosocomial pathogens and
vectors for cross-transmission [35,36]. Banknotes
and coins can also serve as pathogen reservoirs
[1 7] . Moreover, various inanimate objects in the
operating room theatre that are directly or indi-
rectly associated with surgical procedures were
found to be variously contaminated with known
bacterial and fungal pathogens (Box 1) .
Banknotes can serve as a potential source
of pathogens and, in a study from India,
the greatest number of S. aureus isolates was
found on paper currency that was recovered
from hospitals [17] . In addition, it was found
that epidemic nosocomial and community-
acquired MRSA can easily survive on coins
when soil (pus and blood) was also present [2].
Over half of the surface samples from hospitals
in the USA and Ireland were found to be con-
taminated with MRSA, including those taken
from beds and mattresses, and the strains
were similar to those isolated from patients
[37,38]. Cell phones could also be a source of
pathogens, and in Saudi Arabia, coagulase-
negative staphylococci and antibiotic-resistant
Micrococcus spp. were isolated from cell phones
[26] . Contamination of the faucet handles of
the single sink used for hand washing by
technol ogists in the work area was responsi-
ble for an outbreak of Shigella sonnei in the
Rhode Island Hospital [39] . Moreover, hos-
pital personnel may transmit C. difficile to
susceptible patients by transient carriage on
their hands. The same strain of C. difcile
was isolated from the hands of children and
teachers in a diarrheal outbreak in a day-care
setting [40]. In summary, evidence from health-
care studies and outbreaks has revealed that
fomites, including money and coins, can serve
as reservoirs of nosocomial pathogens.
Fomites & money in the spread of
food-borne outbreaks
Evidence for the transmission of pathogens
through contact with fomites is provided by
food-borne outbreaks [3] . Foods can become con-
taminated with pathogens at any point during
their production, processing and preparation.
In many food outlets, workers handle money
and prepare food at the same time. In addition,
pathogens of the nose, throat, feces or skin can
be transmitted by hands, highlighting the need
for hand hygiene. Moreover, other barriers to
pathogen contamination can be used, such as no
hand contact with ready-to-eat food [3].
The agents most likely to be transmitted by
food workers are HAV, Norovirus, Shigella sp.,
Salmonella sp. and S. aureus [4] . In a recent study,
the number of bacteria on banknotes obtained
from food outlets varied widely within a single
country and between individual countries [11] .
Salmonella sp., E. coli and S. aureus were isolated
from the banknotes of most countries [11] . In
Escherichia coli
Bacillus sp.
Staphylococcus aureus
Coagulase-negative staphylococci
Pseudomonas aeruginosa
Pseudomonas sp.
Salmonella sp.
Enterococcus sp.
Klebseilla sp.
Proteus mirabilis
Acinetobacter sp.
Enterobacter spp.
Aspergillus niger
Candida spp.
Fusarium spp.
Rhizopus spp.
Penicillium spp.
USA
Israel
Kenya
Europe
Australia
Canada
Japan
Roseomonas pecuniae
Micrococcus spp.
Kocuria palustris
Brachybacterium conglomeratum
Serratia sp.
Moraxella spp.
Stenotrophomonas maltophilia
Altenaria spp.
Cryptococcus spp.
Figure 3. Infectious agents isolated from coins from dierent countries.
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Bangladesh, banknotes collected from fish sell-
ers, meat sellers, vegetable sellers, food vendors
and shopkeepers were contaminated with E. coli,
Klebsiella sp., Salmonella sp., S. aureus, Bacillus
sp., Pseudomonas sp. and V. cholera; the highest
numbers of isolates were recovered from curren-
cies obtained from the fish and meat sellers [21] .
In Nepal, 62% of the currency notes obtained
from food sellers were found to be contaminated
[20] , while in Kenya, banknotes collected from
greengrocers, butchers, food kiosk/restaurant
attendants and roast maize vendors were also
highly contaminated [22] . In addition, yeast
fungi, including A. niger, Penicillium spp.,
Candida spp. and Cryptococcus spp., were iso-
lated from coins collected from butchers, maize
roasters and food kiosk attendants in Kenya [22].
In summary, money collected from food sell-
ers is highly contaminated, and the presence of
infectious agents on banknotes or coins is indica-
tive of poor hygiene in the person who recently
handled the banknotes or coins. Moreover, the
manner in which the banknotes or coins were
kept in food outlets can influence the presence
of these infectious agents on the currency.
Experimental evidence of pathogen
transfer by banknotes and coins
Laboratory simulations have shown that path-
ogens can survive on banknotes and coins.
Moreover, indirect evidence of hand-to-hand and
fomite-to-hand contact has shown that bank-
notes and coins are viable modes of transmission.
In addition, it seems that wet hands can transfer
larger numbers of infectious agents [41,42] and
that the transfer of pathogens can easily occur
when fingers are moist [43].
Bacteria
Due to the differences between the textures of
paper notes and the metal alloys used for coins,
paper notes can accommodate a variety of con-
taminants, and these contaminants can persist
for longer periods (Table 2) [10] . The inoculation
of S. aureus onto paper currency revealed that all
of the isolates were able to survive for 8 days at
room temperature [17] . On paper surfaces, E. coli
was reduced by almost 10
5
in 24 h, whereas P.
aeruginosa and Enterococcus hirae were more
resistant to room conditions, and were reduced
by only 10
3
after 7 days [44] . In addition, E. coli
was able to be transmitted from one persons
hands to paper and back to another persons
hands [44], and C. albicans was able to survive
in hands and on inanimate surfaces, and could
be transmitted with hand contact (Table 3) [45].
Sufficient bacteria numbers to represent a poten-
tial hazard if in contact with food occurred when
surfaces contaminated with E. coli, Salmonella
spp. or S. aureus came into contact with fingers,
a steel bowl or laminate surfaces [46]. In a recent
study, nonporous surfaces had a greater trans-
fer efficiency for E. coli, S. aureus and Bacillus
thuringiensis than porous surfaces [4 7] . Moreover,
the transfer efficiencies were higher under high
relative humidity for both porous and nonporous
surfaces [47]. However, the occurrence of patho-
gens on money does not mean that it is effec-
tively transferred to the hands as the transfer
efficiency was least with paper currency under
both low and high relative humidity conditions
for E. coli, S. aureus and B. thuringiensis [47].
In coins, 10
5
CFU/ml of MRSA S. aureus did
not survive 4 h after inoculation [2]. By contrast,
when coins were treated with pus or blood, bac-
teria survived for at least 2 weeks when stored in
the dark at ambient temperature, during which
time the quantitative counts were reduced by
approximately 10 and 100 for blood and pus,
respectively [2]. When 5 × 10
4
CFU of E. coli
O157:H7 and Salmonella enteritidis were applied
to the surfaces of sterile US coins, it was found
that these coins could serve as potential vehicles
for the transmission of pathogens even a few days
after contamination [49] . Moreover, it was found
that E. coli can survive for up to 7 days on coins
[49], whereas bacteria isolated from coins were able
to survive on Cu surfaces for 48 h or more [28] .
In conclusion, laboratory experiments
revealed that bacteria are able to survive on
banknotes and coins, and that the potential for
their transmission via money is possible.
Box 1. Commonly used objects by healthcare
workers serving as reservoirs of nosocomial
pathogens.
Cell phone
Toilet paper
Pen
Stethoscope
Paper money
Coins
Uniform
Computer keyboard
Books
Paper les
Patient equipment, such as beds and bedding
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Virus
Although viruses have not been found on money,
the potential for their transmission via money
is possible. Laboratory simulations have dem-
onstrated that the efficiency of viral transmis-
sions varies according to viral strain, the nature
of the host cells and surfaces, and atmospheric
conditions [53] .
Human influenza viruses were able to survive
and remain infectiousness for days when they
were deposited on banknotes [48]. Moreover, the
virus concentration and presence of a beneficial
microenvironment are critical for the duration
of viral infectiousness [48]. The concentration
of H1N1 deposited on hands by coughing or
sneezing was <2.15 × 10 to 2.94 × 10 tissue cul-
ture infectious dose (TCID)
50
/ml [53] , and a 10
3
to 10
4
reduction of H1N1 after 2 min of arti-
ficial inoculation onto human hands has been
reported (Table 3) [52] . Influenza virus deposited at
a concentration of 8.9 × 10
5
TCID
50
/ml was able
to survive for up to 17 days, but the concentra-
tion of virus diluted in mucus and deposited on
banknotes was rapidly decreased (100-fold after
2 h and 10
5
-fold after 2 weeks) [48] . Influenza-
contaminated hands can transfer the viruses
to other surfaces or subjects [58,59], and hands
could become contaminated with influenza by
coming into contact with surfaces inoculated
with viral secretions containing between 10
5
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Table 2. Laboratory simulations demonstrating the survival of pathogens on money.
Type of money Agent Concentration Survival Transfer Ref.
Banknotes Inuenza A (H3N2) 8.9 × 10
5
TCID
50
/ml 2 h NT [48]
Inuenza A (H3N2) and mucus 8.9 × 10
5
TCID
50
/ml 8 days NT [48]
Inuenza B 3.2 × 10
3
TCID
50
/ml 1 day NT [48]
Inuenza B and mucus 3.2 × 10
3
TCID
50
/ml 2 h NT [48]
Coins Staphylococcus aureus (MRSA) 10
5
CFU/ml 4 h NT [2]
S. aureus (MRSA) and organic soil
component
10
5
CFU/ml 13 days NT [2]
Escherichia coli O157:H7 5 × 10
4
CFU 7 days Yes [49]
Salmonella enteritidis 5 × 10
4
CFU 1 day NT [49]
HSV-1 Decrease of
2–3 log in 1 h
NT [50]
NT: Not tested; TCID: Tissue culture infectious dose.
Table 3. Laboratory simulations of the potential transmission of pathogens by fomites.
Infectious agents Concentration Material Survival Hand-to-hand or
fomite-to-hand transfer
Ref.
Bacteria
Staphylococcus aureus 10
5
CFU/ml Fabric NT Yes [43,46]
Escherichia coli 2.75 × 10
7
CFU/ml Paper 10
5
in 24 h Yes [44]
Pseudomonas
aeruginosa
2.75 × 10
7
CFU/ml Paper 10
3
in 7 days Yes [44]
Fungi
Candida albicans 10
5
CFU/ml Hands 24 h Yes [45]
Virus
Inuenza 10
3
TCID
50
/ml Tissue 15 min Yes [51]
10
7
TCID
50
/0.1 ml Hands 10
3
reduction
after 2 min
Yes [52 ]
<2.15 × 10 to
2.94×10 TCID
50
/ml
Hands 5 min NT [53]
Rhinovirus [54]
Hepatitis A virus 10
5
PFU or 6×10
4
PFU
Hands NT Yes [55,56]
Rotavirus 4 × 10
4
PFU Hands 7% alive after
240 min
Yes [57 ]
NT: Not tested; TCID: Tissue culture infectious dose.
257
and 10
7
TCID
50
/ml [51] . In addition, coins con-
taminated with HSV-1 exhibited a decrease of
100–1000 in the viral concentration within 1 h
of contamination [50] .
Although they have not been tested, many
other viruses are stable in the environment and
exhibit high infectivity and, thus, could pos-
sibly be transferred by money and coins. The
transmission of Rhinovirus was very efficient
by hand-to-hand contact [6062], and 50% of
subjects developed an infection after handling
a coffee cup contaminated with Rhinovirus
[54] . However, other studies contradict the ef-
ciency of rhinovirus spread by direct and indirect
hand-to-hand contact with self-inoculation [63].
In addition, the spread of HAV, Rotavirus and
Astrovirus from hands to fomites and vice versa
has been well documented in several experimen-
tal models. Astroviruses exhibited a notable per-
sistence when dried on porous and nonporous
materials, particularly at low temperature [64] . A
longer survival period was found for Rotavirus
on nonporous surfaces at low temperature and
humidity [65] . Moreover, Rotaviruses can survive
for extended periods when dried in fecal matter
[66], and contact between a contaminated and
clean hand 20 and 60 min after rotavirus inocu-
lation resulted in the transfer of 6.6 and 2.8%,
respectively, of the original infectious virus [57] .
Considerable amounts of HAV remained infec-
tious on the finger pads 4 h after infection [55] ,
and contaminated finger pads transferred 9% of
deposited HAV to lettuce [56].
In summary, laboratory simulations have
revealed that the transmission of virus via
banknotes and coins is possible.
Prevention
Money can provide an indirect route for
hand-to-hand contamination, and hand washing
is critical after handling money if a clinical or
food preparation procedure is to be performed.
Many pathogenic or antibiotic-resistant bacteria
have been isolated from various coins and paper
money collected from medical staff and food
handlers [2]. Moreover, the possibility that ter-
rorists could contaminate banknotes with patho-
gens and then put those notes back into circula-
tion has been proposed [67 ] . As a result, microbial
testing of banknotes and replacement of con-
taminated notes, and the regular withdrawal of
damaged notes by federal authorities is recom-
mended. Antimicrobial polymer materials can
also be used in the manufacture of banknotes
and banknote paper can be treated with anti-
microbial-active compounds, which prevent
the growth of microorganisms on banknotes
and consequently limit risks of contamination
during handling [68]. In addition, the banknote
paper can be treated with metallic ions, which
are known to have a wide range of antibacterial
properties.
Hands are the most important fomites for the
spread of nosocomial infection. Alcohol-based
hand rubs can improve compliance with hand
hygiene and reduce the transmission of patho-
genic agents [69 ] . In addition, routine surface
disinfection is crucial to control the spread of
nosocomial pathogens. However, the disinfec-
tion and hygiene intervention studies conducted
so far could not determine a definitive causal
relationship due to the lack of statistical sig-
nificance, presence of confounding factors or
absence of randomization [1,70].
An essential measure for preventing food-
borne outbreak is hygiene training for food
handlers. Many food outlets heavily rely on
the exchange of money for food. The possibil-
ity that the handling of money might result in
food contamination should bring about changes
regarding how foods are handled and traded.
Appropriate and regular hand hygiene, particu-
larly after toilet visits and handling money, is
critical. In addition, food-handling tools can
help prevent cross-contamination occurring
between money and food through contact with
the hands if workers cannot or will not wash
hands between tasks. Routine vaccination of
food handlers for HAV infection can reduce the
foodborne transmission of HAV.
Conclusion
In this review, we show that contaminated money
and coins are a public health risk when associ-
ated with the simultaneous handling of food, and
currency may spread nosocomial infections. We
have highlighted the potential for banknotes and
coins to carry bacteria and fungi, as well as their
potential capacity to spread infectious agents. In
addition, banknotes and monetary coinage can
act as potential reservoirs for antibiotic-resistant
bacteria, such as MRSA [2]. Many food handlers
do not give much attention to hygienic practices,
and money recovered from food handlers was
highly contaminated. As a result, the presence
of pathogens, such as E. coli and Salmonella spp.,
in currency can be potentially detrimental. E. coli
and Salmonella spp. are indicators of poor hygiene
Currency & transmissible diseases REVIEW
future science group
www.futuremedicine.com
Future Microbiol. (2014) 9(2)
258
and sanitation standards, and typically associ-
ated with fecal contamination. Studies highlight
the importance of humidity in the organism
fomite-to-finger transfer efficiency rates but there
are no standard methods for quantifying transfer
rates in the organism fomite-to-finger transfer,
and it is difficult to compare the results from
various studies [47]. Unwashed hands resulted in
greater fomite-to-finger microbial transfer ef-
ciencies. It is possible that the changes in mois-
ture level and pH on skin from hand washing or
other residual effects from soap may contribute
to this effect [ 71] . Therefore, important bacterial
transfer efficiency can possibly result after han-
dling money under unwashed-hand conditions.
As a result, we reinforced the need for good hand
hygiene after handling money, especially when
simultaneously handling food and money.
Future perspective
The capacity of banknotes, coins and fomites to
serve as sources of pathogenic agents represents
a major challenge in the 21st century. It is
possible that the replacement of cotton-based
banknotes by substrate material can play an
important role in the reduction of bacterial
concentration [11] . As often occurs during
scientific progress, technological advances in
microbiology can allow scientists to revisit
the knowledge base. Large-scale 16S rRNA
or metagenomic studies could allow scientists
to dramatically expand the known diversity
of contaminants on money and fomites [72].
In addition, ‘microbial culturomics’ studies,
using different atmospheres, temperatures,
pH, nutrients, minerals, antibiotics or phages
can provide comprehensive culture conditions
and significantly increase the number of differ-
ent bacteria isolates from banknotes, coins and
fomites [72,73] . Our knowledge of the poten-
tial role of currency in virus transmission is
limited. In some studies, the enumeration of
bacterial agents was difficult because their
existence was below that of a typical detection
EXECUTIVE SUMMARY
Persistence of pathogens on surfaces
Many bacteria and viruses can survive on surfaces.
Currency notes
Cotton-based banknotes provide a brous surface, which provides ample opportunity for bacterial attachment, and
the longer a paper bill stays in circulation, the more opportunity there is for it to become contaminated.
Various bacteria, yeasts, fungi, cysts and ova of intestinal parasites have been isolated from money worldwide.
Coins
The presence of an appreciable amount of copper in coined metal alloys seems to be the limiting factor for bacterial
survival on coins in general.
Various bacteria, yeasts and fungi have been isolated from coins worldwide.
Fomites & money in the spread of nosocomial infections
In hospitals, surfaces such as beds and keyboards, which have direct contact with hands, serve as reservoirs of
nosocomial pathogens and vectors for cross-transmission.
Banknotes can serve as a potential source of pathogens, and paper currency recovered from hospitals was highly
contaminated by Staphylococcus aureus isolates.
Fomites & money in the spread of food-borne outbreaks
Salmonella species, Escherichia coli and S. aureus are commonly isolated from banknotes from food outlets.
Prepared foods, such as salads, sandwiches and bakery items, are frequently associated with outbreaks of viral food-borne
disease.
Experimental evidence of pathogen transfer by banknotes & coins
In laboratory simulations, methicillin-resistant S. aureus can easily survive on coins.
In experimental models, human inuenza virus, Norovirus, Rhinovirus, hepatitis A virus and Rotavirus were able to be
transmitted through hand-to-hand contact.
Prevention
Hygiene training, including training in the techniques of hand washing and disinfection, is an essential measure for
preventing nosocomial and food-borne outbreaks.
REVIEW Angelakis, Azhar, Bibi et al.
future science group
259
for enumeration [11] . Concerning the pres-
ence of virus in currency, classical methods,
including isolation and culture of the virus, can
improve our knowledge, although frequently,
the virus cannot be cultivated under labora-
tory conditions or the virus does not exhibit its
characteristic cytopathic effects in culture [74].
Viral metagenomics are particularly suitable
for providing a global overview of the diversity
of the viral community and possess functional
potential [74].
Financial & competing interests disclosure
This work was funded by the Deanship of Scientific Research,
King Abdulaziz University, under grant number (1-141/1433
HiCi). The authors, therefore, acknowledge technical and
financial support of King Abdulaziz University. The authors
have no other relevant affiliations or financial involvement
with any organization or entity with a financial interest in
or financial conflict with the subject matter or materials dis-
cussed in the manuscript apart from those disclosed.
No writing assistance was utilized in the production of
this manuscript.
References
Papers of special note have been highlighted as:
l●
of interest
l●●l●
of considerable interest
1 Pittet D, Allegranzi B, Sax H et al. Evidence-
based model for hand transmission during
patient care and the role of improved
practices. Lancet Infect. Dis. 6(10), 641–652
(2006).
l●●l●
Proposes a dynamic model for hand hygiene
research and education strategies, together
with corresponding indications for hand
hygiene during patient care.
2 Tolba O, Loughrey A, Goldsmith CE, Millar
BC, Rooney PJ, Moore JE. Survival of
epidemic strains of nosocomial- and
community-acquired methicillin-resistant
Staphylococcus aureus on coins. Am. J. Infect.
Control 35(5), 342–346 (2007).
3 Todd EC, Greig JD, Bartleson CA, Michaels
BS. Outbreaks where food workers have been
implicated in the spread of foodborne disease.
Part 6. Transmission and survival of
pathogens in the food processing and
preparation environment. J. Food Prot. 72(1),
202–219 (2009).
4 Todd EC, Greig JD, Bartleson CA, Michaels
BS. Outbreaks where food workers have been
implicated in the spread of foodborne disease.
Part 4. Infective doses and pathogen carriage.
J. Food Prot. 71(11), 2339–2373 (2008).
5 Dirty paper money. Can. Med. Assoc. J. 14(4),
331 (1924).
6 Abrams BL, Waterman NG. Dirty money.
JAMA 219(9), 1202–1203 (1972).
l●
First study of the bacterial contamination of
bank notes.
7 Taylor J, Davies M, Canales M, Lai KM. The
persistence of flood-borne pathogens on
building surfaces under drying conditions.
Int. J. Hyg. Environ. Health 216(1), 9199
(2013).
8 Kramer A, Schwebke I, Kampf G. How long
do nosocomial pathogens persist on inanimate
surfaces? A systematic review. BMC Infect.
Dis. 6, 130 (2006).
l●●l●
Systematic review of the literature on the
survival of nosocomial pathogens on
inanimate surfaces.
9 Lopman B, Gastanaduy P, Park GW, Hall AJ,
Parashar UD, Vinje J. Environmental
transmission of norovirus gastroenteritis.
Curr. Opin. Virol. 2(1), 96–102 (2012).
10 El-Dars FM, Hassan WM. A preliminary
bacterial study of Egyptian paper money. Int.
J. Environ. Health Res. 15(3), 235–239
(2005).
11 Vriesekoop F, Russell C, Alvarez-Mayorga B
et al. Dirty money: an investigation into the
hygiene status of some of the worlds
currencies as obtained from food outlets.
Foodborne Pathog. Dis. 7(12), 1497–1502
(2010).
l●
Tested a very large number of banknotes
obtained from food outlets in ten different
countries.
12 Al-Ghamdi AK, Abdelmalek SM, Bamaga
MS, Azhar EI, Wakid MH, Alsaied Z.
Bacterial contamination of Saudi “one” Riyal
paper notes. Southeast Asian J. Trop. Med.
Public Health 42(3), 711716 (2011).
13 Pope TW, Ender PT, Woelk WK, Koroscil
MA, Koroscil TM. Bacterial contamination
of paper currency. South Med. J. 95(12),
1408–1410 (2002).
14 Tagoe DN, Baidoo SE, Dadzie I, Ahator D.
A study of bacterial contamination of
Ghanaian currency notes in circulation. Int. J.
Microbiol. 8(2) (2010).
15 Khin NO, Phyu PW, Aung MH, Aye T.
Contamination of currency notes with enteric
bacterial pathogens. J. Diarrhoeal Dis. Res.
7(34), 92–94 (1989).
16 Umed EU, Juluku JU, Ichor T. Microbial
contamination of ‘Naira’ (Nigerian currency)
notes in circulation. Res. J. Environ. Sci. 1(6),
336–339 (2007).
17 Kumar JD, Negi YK, Gaur A, Khanna D.
Detection of virulence genes in Staphylococcus
aureus isolated from paper currency. Int.
J. Infect. Dis. 13(6), e450e455 (2009).
18 Elumalai EK, David E, Hemachandran J.
Bacterial contamination of Indian currency
notes (Rupee). Int. J. Occup. Environ. Med.
3(4), 204–205 (2012).
19 Basavarajappa KG, Rao PN, Suresh K. Study
of bacterial, fungal, and parasitic
contaminaiton of currency notes in
circulation. Indian J. Pathol. Microbiol. 48(2),
278–279 (2005).
20 Lamichhane J, Adhikary S, Gautam P,
Maharjan R, Dhakal B. Risk of handling
paper currency in circulation chances of
potential bacterial transmittance. Nepal J. Sci.
Technol. 10(2009), 161–166 (2009).
21 Uddin A, Parveen S, Nasreen T, Feroza B.
Evaluation of the microbial contamination of
Bangladesh paper currency notes (Taka) in
circulation. Adv. Biol. Res. 4(5), 266–271
(2010).
22 Kuria JK, Wahome RG, Jobalamin M,
Kariuki SM. Profile of bacteria and fungi on
money coins. East African Med. J. 86(4),
151155 (2009).
23 Hosen MJ, Sarif DI, Rahman M, Azad KA.
Contamination of coliforms in different paper
currency Notes of Bangladesh. Pakistan J.
Biol. Sci. 9(5), 868870 (2006).
24 El Dars F, Hassar M. A preliminary bacterial
study of Egyptian paper money. Int. J.
Environ. Health Res. 15(3), 235–239 (2005).
25 Goktas P, Oktay G. Bacteriological
examination of paper money. Mikrobiyol. Bul.
26(4), 344–348 (1992).
26 Alwakeel SS, Nasser LA. Bacterial and fungal
contamination of Saudi Arabian paper
currency and cell phones. Asian J. Biol. Sci.
4(7), 556–562 (2011).
27 Saeed S, Rasheed H. Evaluation of bacterial
contamination of Pakistani currency notes in
circulation in Karachi. Eur. J. Biol. Sci. 3,
9498 (2011).
28 Espirito Santo C, Morais PV, Grass G.
Isolation and characterization of bacteria
Currency & transmissible diseases REVIEW
future science group
www.futuremedicine.com
Future Microbiol. (2014) 9(2)
260
resistant to metallic copper surfaces. Appl.
Environ. Microbiol. 76(5), 1341–1348 (2010).
29 Uneke CJ, Ogbu O. Potential for parasite and
bacteria transmission by paper currency in
Nigeria. J. Environ. Health 69(9), 5460
(2007).
30 Rote RB, Deogade NG, Kawale M. Isolation,
characterization and antibiotic sensitivity of
organism from Indian currency. Asiatic J.
Biotechnol. Res. 3, 255–260 (2010).
31 Xu J, Moore JE, Millar BC. Ribosomal DNA
(rDNA) identification of the culturable
bacterial flora on monetary coinage from 17
currencies. J. Environ. Health 67(7), 51–55
(2005).
32 Espirito Santo C, Lin Y, Hao X, Wei G,
Rensing C, Grass G. Draft genome sequence
of Pseudomonas psychrotolerans L19, isolated
from copper alloy coins. J. Bacteriol. 194(6),
16231624 (2012).
33 Lopes A, Espirito Santo C, Grass G, Chung
AP, Morais PV. Roseomonas pecuniae sp. nov.,
isolated from the surface of a copper-alloy
coin. Int. J. Syst. Evol. Microbiol. 61(Pt 3),
610 615 (2011).
34 Laborde DJ, Weigle KA, Weber DJ, Kotch JB.
Effect of fecal contamination on diarrheal
illness rates in day-care centers. Am. J.
Epidemiol. 138(4), 243–255 (1993).
35 Catalano M, Quelle LS, Jeric PE, Di Martino
A, Maimone SM. Survival of Acinetobacter
baumannii on bed rails during an outbreak
and during sporadic cases. J. Hosp. Infect.
42(1), 27–35 (1999).
36 Bures S, Fishbain JT, Uyehara CF, Parker JM,
Berg BW. Computer keyboards and faucet
handles as reservoirs of nosocomial pathogens
in the intensive care unit. Am. J. Infect.
Control 28(6), 465471 (2000).
37 Sexton T, Clarke P, O’Neill E, Dillane T,
Humphreys H. Environmental reservoirs of
methicillin-resistant Staphylococcus aureus in
isolation rooms: correlation with patient
isolates and implications for hospital hygiene.
J. Hosp. Infect. 62(2), 187–194 (2006).
38 Boyce JM, Potter-Bynoe G, Chenevert C,
King T. Environmental contamination due to
methicillin-resistant Staphylococcus aureus:
possible infection control implications. Infect.
Control. Hosp. Epidemiol. 18(9), 622627
(1997).
39 Mermel LA, Josephson SL, Dempsey J,
Parenteau S, Perry C, Magill N. Outbreak of
Shigella sonnei in a clinical microbiology
laboratory. J. Clin. Microbiol. 35(12),
31633165 (1997).
40 Kim K, DuPont HL, Pickering LK.
Outbreaks of diarrhea associated with
Clostridium difcile and its toxin in day-care
centers: evidence of person-to-person spread.
J. Pediatr. 102(3), 376–382 (1983).
41 Marples RR, Towers AG. A laboratory model
for the investigation of contact transfer of
micro-organisms. J. Hyg. (Lond.) 82(2),
237–248 (1979).
42 Patrick DR, Findon G, Miller TE. Residual
moisture determines the level of touch-
contact-associated bacterial transfer following
hand washing. Epidemiol. Infect. 119(3),
319325 (1997).
43 Sattar SA, Springthorpe S, Mani S et al.
Transfer of bacteria from fabrics to hands and
other fabrics: development and application of
a quantitative method using Staphylococcus
aureus as a model. J. Appl. Microbiol. 90(6),
962–970 (2001).
44 Hubner NO, Hubner C, Kramer A, Assadian
O. Survival of bacterial pathogens on paper
and bacterial retrieval from paper to hands:
preliminary results. Am. J. Nurs. 111(12),
30–34 (2011).
45 Rangel-Frausto MS, Houston AK, Bale MJ,
Fu C, Wenzel RP. An experimental model for
study of Candida survival and transmission in
human volunteers. Eur. J. Clin. Microbiol.
Infect. Dis. 13(7), 590–595 (1994).
46 Scott E, Bloomfield SF. The survival and
transfer of microbial contamination via
cloths, hands and utensils. J. Appl. Bacteriol.
68(3), 271–278 (1990).
47 Lopez GU, Gerba CP, Tamimi AH, Kitajima
M, Maxwell SL, Rose JB. Transfer efficiency
of bacteria and viruses from porous and
nonporous fomites to fingers under different
relative humidity conditions. Appl. Environ.
Microbiol. 79(18), 5728–5734 (2013).
l●
Very recent study in which the effect of low
and high relative humidity on bank note to
finger transfer efficiency was tested.
48 Thomas Y, Vogel G, Wunderli W et al. Survival
of influenza virus on banknotes. Appl. Environ.
Microbiol. 74(10), 3002–3007 (2008).
l●
In this study, it was found that influenza
virus can survive on banknotes.
49 Jiang X, Doyle MP. Fate of Escherichia coli
O157:H7 and Salmonella enteritidis on
currency. J. Food Prot. 62(7), 805807
(1999).
50 Bardell D. Studies on the survival and
inactivation of herpes simplex virus type 1 on
coins. Microbios 77(312), 161–166 (1994).
51 Bean B, Moore BM, Sterner B, Peterson LR,
Gerding DN, Balfour HH Jr. Survival of
influenza viruses on environmental surfaces.
J. Infect. Dis. 146(1), 47–51 (1982).
52 Grayson ML, Melvani S, Druce J et al. Efficacy
of soap and water and alcohol-based hand-rub
preparations against live H1N1 influenza virus
on the hands of human volunteers. Clin. Infect.
Dis. 48(3), 285–291 (2009).
53 Mukherjee DV, Cohen B, Bovino ME, Desai
S, Whittier S, Larson EL. Survival of
influenza virus on hands and fomites in
community and laboratory settings. Am. J.
Infect. Control 40(7), 590–594 (2012).
54 Gwaltney JM Jr, Hendley JO. Transmission of
experimental rhinovirus infection by
contaminated surfaces. Am. J. Epidemiol.
116(5), 828833 (1982).
55 Mbithi JN, Springthorpe VS, Boulet JR,
Sattar SA. Survival of hepatitis A virus on
human hands and its transfer on contact with
animate and inanimate surfaces. J. Clin.
Microbiol. 30(4), 757–763 (1992).
56 Bidawid S, Farber JM, Sattar SA.
Contamination of foods by food handlers:
experiments on hepatitis A virus transfer to
food and its interruption. Appl. Environ.
Microbiol. 66(7), 2759–2763 (2000).
57 Ansari SA, Sattar SA, Springthorpe VS, Wells
GA, Tostowaryk W. Rotavirus survival on
human hands and transfer of infectious virus
to animate and nonporous inanimate surfaces.
J. Clin. Microbiol. 26 (8 ), 1513 1518 (1988).
58 Barker J, Vipond IB, Bloomfield SF. Effects of
cleaning and disinfection in reducing the
spread of Norovirus contamination via
environmental surfaces. J. Hosp. Infect. 58(1),
4249 (2004).
59 Rheinbaben F, Schunemann S, Gross T,
Wolff MH. Transmission of viruses via
contact in a household setting: experiments
using bacteriophage straight phiX174 as a
model virus. J. Hosp. Infect. 46(1), 61–66
(2000).
60 Gwaltney JM Jr., Moskalski PB, Hendley JO.
Hand-to-hand transmission of rhinovirus
colds. Ann. Intern. Med. 88(4), 463467
(1978).
61 Gwaltney JM, Hendley JO. Rhinovirus
transmission: one if by air, two if by hand.
Trans. Am. Clin. Climatol. Assoc. 89, 194–200
(1978).
62 Hendley JO, Wenzel RP, Gwaltney JM Jr.
Transmission of rhinovirus colds by
self-inoculation. N. Engl. J. Med. 288(26),
1361–1364 (1973).
63 Dick EC, Jennings LC, Mink KA, Wartgow
CD, Inhorn SL. Aerosol transmission of
rhinovirus colds. J. Infect. Dis. 156 (3),
442–448 (1987).
64 Abad FX, Villena C, Guix S, Caballero S,
Pinto RM, Bosch A. Potential role of fomites
REVIEW Angelakis, Azhar, Bibi et al.
future science group
261
in the vehicular transmission of human
astroviruses. Appl. Environ. Microbiol. 67(9),
3904–3907 (2001).
65 Sattar SA, Lloyd-Evans N, Springthorpe VS,
Nair RC. Institutional outbreaks of rotavirus
diarrhoea: potential role of fomites and
environmental surfaces as vehicles for virus
transmission. J. Hyg. (Lond.) 96(2), 277–289
(1986).
66 Ward RL, Bernstein DI, Knowlton DR et al.
Prevention of surface-to-human transmission
of rotaviruses by treatment with disinfectant
spray. J. Clin. Microbiol. 29(9), 19911996
(1991).
67 Spivack N. The threat of contaminated money:
proposed solutions (2005).
www.novaspivack.com/best-articles/the-threat-
of-contaminated-money-proposed-solutions
68 Renaud FN, Rosset H, Vast N. A treatment
for banknotes against viruses, bacteria and
fungi. BMC Proc. 5(Suppl. 6), O37 (2011).
69 Boyce JM, Pittet D. Guideline for hand
hygiene in health-care settings.
Recommendations of the Healthcare
Infection Control Practices Advisory
Committee and the HICPAC/SHEA/APIC/
IDSA Hand Hygiene Task Force. Society for
Healthcare Epidemiology of America/
Association for Professionals in Infection
Control/Infectious Diseases Society of
America. MMWR Recomm. Rep. 51(RR-16),
1–45, quiz CE1–4 (2002).
70 Ward DJ. Hand adornment and infection
control. Br. J. Nurs. 16(11), 654656 (2007).
71 Gfatter R, Hackl P, Braun F. Effects of soap
and detergents on skin surface pH, stratum
corneum hydration and fat content in infants.
Dermatology 195(3), 258 262 (1997).
72 Lagier JC, Million M, Hugon P, Armougom
F, Raoult D. Human gut microbiota:
repertoire and variations. Front. Cell. Infect.
Microbiol. 2, 136 (2012).
73 Lagier JC, Armougom F, Million M et al.
Microbial culturomics: paradigm shift in
the human gut microbiome study. Clin.
Microbiol. Infect. 18(12), 1185–1193
(2012).
l●●l●
In this study, different culture conditions for
the isolation of different bacteria species
were proposed.
74 Fancello L, Raoult D, Desnues C.
Computational tools for viral metagenomics
and their application in clinical research.
Virology 434(2), 162–174 (2012).
future science group
www.futuremedicine.com
Currency & transmissible diseases REVIEW
... Money has been found to include a variety of microbes from all across the world, even wealthy countries. Bacillus sp. and Staphylococcus aureus have been recovered from paper currency and have been found as prevalent pollutants [2][3][4][5]. Other species have been recovered from currency, including Micrococcus sp., Corynebacterium sp., Vibrio cholerae, Mycobacterium tuberculosis, and representatives of the Enterobacteriacea family. ...
... This is to be anticipated, given lesser denomination coins are exchanged more frequently than larger denomination coins. Currency taint was shown to be greater in our research than in other poor countries' currencies [1][2][3]. In our research, currency coins from the public market area had higher E. coli infection (36%) than those from the hospital (25%) category, while S. aureus infection was higher in the healthcare group (54%) than in the marketplace group (38 percent ). ...
Article
Full-text available
Every day, individuals in all societies exchange cash, so mixing bank coins could serve as a medium for bacterial infection transmission. Many countries have looked into the function of coins in the transmission of pathogenic microflora. Metallic alloys have recently attracted a lot of attention as a new antibacterial weapon for sectors where surface hygiene is crucial. In the environment and among humans, currency coins aid as a universal medium for the blowout of microbes. The goal of our research is to quantify and liken the overall microbial load of Pseudomonas sp., Staphylococcus aureus, E. coli, Bacillus sp., Klebsiella sp., Salmonella sp., and Proteus species exist on money coins mingling in the market arena and hospital counter. Separation of Gram positive and negative sp., from coins indicated that coins may play an essential function as a vector in the spread of pathogenic microbes in the communal in the current investigation. The pathogenic microbesidentified on money coins, such as E. coli, S. aureus, Bacillus sp., Klebsiella sp., Salmonella sp., and Pseudomonas sp., can cause a wide range of illnesses, including food intoxication, wound infections, skin contagions, respiratory issues, and gastrointestinal complications.
... These aforementioned works are contextualized in a pre-COVID-19 world. The pandemic, however, has narrowed options for usable payments; because the virus can spread through aerosolization [7] and potentially via physical currency [8], sellers and buyers may find themselves in situations where in-person payments are not safe, rendering prior payment methods unusable. In some regions, restrictions on gathering size and dine-in restaurants spurred the adoption of digital payment options [2]. ...
Preprint
Since the COVID-19 pandemic, businesses have faced unprecedented challenges when trying to remain open. Because COVID-19 spreads through aerosolized droplets, businesses were forced to distance their services; in some cases, distancing may have involved moving business services online. In this work, we explore digitization strategies used by small businesses that remained open during the pandemic, and survey/interview small businesses owners to understand preliminary challenges associated with moving online. Furthermore, we analyze payments from 400K businesses across Japan, Australia, United States, Great Britain, and Canada. Following initial government interventions, we observe (at minimum for each country) a 47% increase in digitizing businesses compared to pre-pandemic levels, with about 80% of surveyed businesses digitizing in under a week. From both our quantitative models and our surveys/interviews, we find that businesses rapidly digitized at the start of the pandemic in preparation of future uncertainty. We also conduct a case-study of initial digitization in the United States, examining finer relationships between specific government interventions, business sectors, political orientation, and resulting digitization shifts. Finally, we discuss the implications of rapid & widespread digitization for small businesses in the context of usability challenges and interpersonal interactions, while highlighting potential shifts in pre-existing social norms.
... This means that visiting financial institutions, markets, and other public places in many countries is prohibited. Again, previous studies suggest that money in the form of paper and coins could transmit bacteria and viruses (Angelakis, 2014;Adinortey, et al., 2011). This presupposes that the use of digital money transacted via the internet can to an extent reduce the spread of bacteria and viruses because physical contact is avoided. ...
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Covid-19 transformed mobile payment services (MPS) diffusion pattern globally. Consequently, the need to examine factors contributing to the diffusion rate of MPS in this era is substantiated. Thus, this study employs Structural Equation Model (SEM) with social media administered survey data to estimate the nexus between MPS diffusion and technological factors, non-technological factors, and environmental factors. Results suggest that although MPS diffusion increased globally, mobile payment services have the highest diffusion rate. This is because of convenience, availability, and cost. Further, technological, non-technological, and environmental factors all contribute positively to the high rate of diffusion. Environmental factors like an escalation in the Covid-19 cases, recommendations from the center for disease control positively mediates the relationship between MPS diffusion and non-technological factors. Thus, to encourage mass diffusion and continual usage of MPS during and after the pandemic, cost of usage, convenience, accessibility, and mobile-based applications should be bundled for optimized user experience.
... Depending on initial viral titers a significant amount of virus can be transferred and subsequently recovered from the VITRO Skinâ, which helps to calculate the risk of transmission by contact to contaminated surfaces. Indeed, frequently touched objects have been suspected to serve as vehicles for certain pathogens such as bacteria, parasites, fungi, and viruses including SARS-CoV-2 (Angelakis et al., 2014;Pal and Bhadada, 2020). Therefore, data providing information about transmission efficacy can play an important rule when adjusting hygiene measures. ...
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Transmission via fomites poses a major dissemination route for many human pathogens, particularly because of transfer via fingertips. Here, we present a protocol to investigate direct transfer of infectious agents from fomites to humans via naked fingertips. The protocol is suitable for pathogens requiring highest biosafety levels (e.g., SARS-CoV-2). We used an artificial skin to touch a defined volume of virus suspension and subsequent quantification of infectious entities allows quantitative measurement of transfer efficiency and risk assessment. For complete information on the generation and use of this manuscript, please refer to Todt et al. (2021).
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The COVID-19 outbreak has accelerated the use of technology among consumers. Given the perceived health risks associated with using cash, this study aims to investigate the behavioral intention of Malaysians to use e-wallets during the pandemic. How has the pandemic affected consumer adoption of e-wallets? Drawing on the Technology Acceptance Model, a survey of 212 users was conducted to determine how three specific factors (trustworthiness, reliability, and perceived health risk) drive the intention of consumers to use e-wallets. The findings offer insights into the social impact of e-wallets as an innovative form of technology.
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This study proposed a novel attempt to explain the effect of government support and individual's perceived susceptibility to COVID-19 in adopting e-Wallet by integrating technology acceptance model (TAM) and health belief model (HBM). A total of 232 valid responses were collected through online survey. The hypotheses were analysed and validated by using the partial least square structural equation modelling (PLS-SEM) approach. The study found that the HBM construct, which is perceived susceptibility, was only mediated by perceived usefulness. Meanwhile, government support was fully mediated by both perceived usefulness and perceived ease of use. The FinTech practitioners should consider the ease of use and usefulness of e-Wallet in fulfilling the needs of the consumers. In addition, instead of subsidising the consumers, the Government should also focus on the public facilities such as the stable connectivity that allow the consumers to stay connected and trust on the connectivity for e-Wallet. This study adopted holistic and integrative modesl which are TAM and HBM to explain the intention to adopt e-Wallet services during COVID-19 pandemic.
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Full-text available
This study proposed a novel attempt to explain the effect of government support and individual's perceived susceptibility to COVID-19 in adopting e-Wallet by integrating technology acceptance model (TAM) and health belief model (HBM). A total of 232 valid responses were collected through online survey. The hypotheses were analysed and validated by using the partial least square structural equation modelling (PLS-SEM) approach. The study found that the HBM construct, which is perceived susceptibility, was only mediated by perceived usefulness. Meanwhile, government support was fully mediated by both perceived usefulness and perceived ease of use. The FinTech practitioners should consider the ease of use and usefulness of e-Wallet in fulfilling the needs of the consumers. In addition, instead of subsidising the consumers, the Government should also focus on the public facilities such as the stable connectivity that allow the consumers to stay connected and trust on the connectivity for e-Wallet. This study adopted holistic and integrative models which are TAM and HBM to explain the intention to adopt e-Wallet services during COVID-19 pandemic.
Article
This study proposed a novel attempt to explain the effect of government support and individual's perceived susceptibility to COVID-19 in adopting e-Wallet by integrating technology acceptance model (TAM) and health belief model (HBM). A total of 232 valid responses were collected through online survey. The hypotheses were analysed and validated by using the partial least square structural equation modelling (PLS-SEM) approach. The study found that the HBM construct, which is perceived susceptibility, was only mediated by perceived usefulness. Meanwhile, government support was fully mediated by both perceived usefulness and perceived ease of use. The FinTech practitioners should consider the ease of use and usefulness of e-Wallet in fulfilling the needs of the consumers. In addition, instead of subsidising the consumers, the Government should also focus on the public facilities such as the stable connectivity that allow the consumers to stay connected and trust on the connectivity for e-Wallet. This study adopted holistic and integrative modesl which are TAM and HBM to explain the intention to adopt e-Wallet services during COVID-19 pandemic.
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The COVID 19 pandemic has triggered concerns and assumptions globally about transmission of the SARS‐CoV‐2 virus via cash transactions. This paper assesses the risk of contracting COVID‐19 through exposure to SARS‐CoV‐2 via cash acting as a fomite in payment transactions. A quantitative microbial risk assessment was conducted for a scenario assuming an infectious person at the onset of symptoms, when virion concentrations in coughed droplets are at their highest. This person then contaminates a banknote by coughing on it and immediately hands it over to another person, who might then be infected by transferring the virions with a finger from the contaminated banknote to a facial mucous membrane. The scenario considered transfer efficiency of virions on the banknote to fingertips when droplets were still wet and after having dried up and subsequently being touched by finger printing or rubbing the object. Accounting for the likelihood of the scenario to occur by considering (1) a local prevalence of 100 COVID‐19 cases/100,000 persons, (2) a maximum of about one‐fifth of infected persons transmit high virus loads, and (3) the numbers of cash transactions/person/day, the risk of contracting COVID‐19 via person‐to‐person cash transactions was estimated to be much lower than once per 39,000 days (107 years) for a single person. In the general populace, there will be a maximum of 2.6 expected cases/100,000 persons/day. The risk for a cashier at an average point of sale was estimated to be much less than once per 430 working days (21 months). The depicted scenario is a rare event, therefore, for a single person, the risk of contracting COVID‐19 via person‐to‐person cash transactions is very low. At a point of sale, the risk to the cashier proportionally increases but it is still low.
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Fomites can serve as routes of transmission for both enteric and respiratory pathogens. The present study examined the effect of low and high relative humidity on fomite-to-finger transfer efficiency of five model organisms from several common inanimate surfaces (fomites). Nine fomites representing porous and nonporous surfaces of different compositions were studied. Escherichia coli, Staphylococcus aureus, Bacillus thuringiensis, MS2 coliphage, and poliovirus 1 were placed on fomites in 10-μl drops and allowed to dry for 30 min under low (15% to 32%) or high (40% to 65%) relative humidity. Fomite-to-finger transfers were performed using 1.0 kg/cm2 of pressure for 10 s. Transfer efficiencies were greater under high relative humidity for both porous and nonporous surfaces. Most organisms on average had greater transfer efficiencies under high relative humidity than under low relative humidity. Nonporous surfaces had a greater transfer efficiency (up to 57%) than porous surfaces (<6.8%) under low relative humidity, as well as under high relative humidity (nonporous, up to 79.5%; porous, <13.4%). Transfer efficiency also varied with fomite material and organism type. The data generated can be used in quantitative microbial risk assessment models to assess the risk of infection from fomite-transmitted human pathogens and the relative levels of exposure to different types of fomites and microorganisms.
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Clin Microbiol Infect 2012; 18: 1185–1193 Comprehensive determination of the microbial composition of the gut microbiota and the relationships with health and disease are major challenges in the 21st century. Metagenomic analysis of the human gut microbiota detects mostly uncultured bacteria. We studied stools from two lean Africans and one obese European, using 212 different culture conditions (microbial culturomics), and tested the colonies by using mass spectrometry and 16S rRNA amplification and sequencing. In parallel, we analysed the same three samples by pyrosequencing 16S rRNA amplicons targeting the V6 region. The 32 500 colonies obtained by culturomics have yielded 340 species of bacteria from seven phyla and 117 genera, including two species from rare phyla (Deinococcus-Thermus and Synergistetes, five fungi, and a giant virus (Senegalvirus). The microbiome identified by culturomics included 174 species never described previously in the human gut, including 31 new species and genera for which the genomes were sequenced, generating c. 10 000 new unknown genes (ORFans), which will help in future molecular studies. Among these, the new species Microvirga massiliensis has the largest bacterial genome so far obtained from a human, and Senegalvirus is the largest virus reported in the human gut. Concurrent metagenomic analysis of the same samples produced 698 phylotypes, including 282 known species, 51 of which overlapped with the microbiome identified by culturomics. Thus, culturomics complements metagenomics by overcoming the depth bias inherent in metagenomic approaches.
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The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission ofpathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
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Cultures of random samples of both coin and paper money revealed that 13% of the coins and 42% of the paper money were contaminated by potential pathogens. The implications lead to the conclusion that no abrupt departure from our present monetary habit is imminent.